Adolescence and Human Sexuality

Human sexuality is a complex phenomenon involving the interaction of biology, sex, core gender identity, and gender role behavior. Successful completion of normal stages of sexuality development is important for children and adolescents to allow for optimal life as an adult. Controversies arise for clinicians as they work with their pediatric patients regarding health care sexuality issues. It is important that clinicians help these patients in an unbiased and neutral manner. As adults, these children and adolescents will function in a number of sexuality roles, whether heterosexual, homosexual, or bisexual. This chapter reviews many of these complex and critical issues that involve the fascinating development of human sexuality in pediatric patients

Marijuana: Current Concepts†

Marijuana (cannabis) remains a controversial drug in the twenty-first century. This paper considers current research on use of Cannabis sativa and its constituents such as the cannabinoids. Topics reviewed include prevalence of cannabis (pot) use, other drugs consumed with pot, the endocannabinoid system, use of medicinal marijuana, medical adverse effects of cannabis, and psychiatric adverse effects of cannabis use. Treatment of cannabis withdrawal and dependence is difficult and remains mainly based on psychological therapy; current research on pharmacologic management of problems related to cannabis consumption is also considered. The potential role of specific cannabinoids for medical benefit will be revealed as the twenty-first century matures. However, potential dangerous adverse effects from smoking marijuana are well known and should be clearly taught to a public that is often confused by a media-driven, though false message and promise of benign pot consumption

Self-Cutting and Suicide in Adolescents

Deliberate self-harm (DSH) is a common and typically secret phenomenon in adolescents, especially females that involves two main features—self-derogation and negative emotionality. Causes of non-suicidal self-injury include attempts to get help from professionals, express disgust or self-anger, resist suicidal thoughts, and correct episodes of dissociation. DSH is associated with eating disorders and alcohol abuse, as well as other illict drug abuse. Fortunately, most self-cutters are not at high risk for eventual suicide; however, all those with DSH histories should be carefully assessed for suicide as well as offered comprehensive management. Programs for prevention of suicide should be implemented for adolescents at risk for suicide and this includes those with histories of DSH

The relationship between deliberate self-harm behavior, body dissatisfaction, and suicide in adolescents: current concepts

Deliberate self-harm (DSH) is a common though often hidden condition in children and adolescents that may result in suicide. This discussion covers several aspects of DSH including its prevalence, etiology, and management. The relationships of DSH to body dissatisfaction and suicide are specifically considered. Even though most cases of DSH do not end in overt suicide, DSH reflects that potential underlying psychological pathophysiology, and likelihood of eventual death from self-murder, cannot always be predicted or prevented. It is important to take all acts of DSH as serious, and to offer comprehensive management to prevent future acts of DSH and potential suicide

Sexually Transmitted Diseases (STDs)

High rates of unprotected sexual behavior in adolescents result in millions of cases of STDs in the world. This chapter reviews factors inducing high STD rates, specific STDs, and their management based on 2010 U.S. Centers for Disease Control and Prevention (CDC) STD guidelines. Clinicians should screen all their sexually active adolescent patients for STDs and provide preventive education as well as treatment measures

The Adolescent Breast

The breast is an important organ system for the adolescent female and occasionally for the adolescent male as well. This chapter reviews basic principles of breast concerns and disorders including congenital anomalies, asymmetric breast development, under-developed breasts, virginal hypertrophy, breast masses, mastaglia, galactorrhea, gynecomastia in males, and others. Clinicians should be attuned to issues and concerns for this important structure in adolescents

Menstrual Disorders in the Adolescent Female

This chapter reviews basic concepts of menstrual disorders in adolescents beginning with an overview of menstrual physiology followed by consideration of various abnormal menstrual patterns: amenorrhea (primary and secondary), dysfunctional uterine bleeding, dysmenorrhea (primary and secondary), and premenstrual syndrome

Concepts of Contraception for Adolescents with Obesity: Pathways of Judicial Moderation

All sexually active youth, whether obese or normal weight, should be offered counseling regarding contraception and appropriate contraceptive methods. However, obese youth who are sexually active may be less likely than their normal weight peers to use contraceptives correctly. Methods of contraception for obese adolescents are reviewed in this discussion. Combined oral contraceptives (COCs) and the contraceptive patch have higher failure rates in obese versus normal weight females, though failure rates are lower than noted with barrier contraceptives. The risk for venous thrombosis is higher in obese youth on COCs. Progestin-only pills and the levonorgestrel intrauterine system appear to be safe and effective methods in obese females. Depotmedroxyprogesterone acetate, intravaginal ring, and implants are also considered

Obesity and Contraception

All sexually active youth, whether obese or normal weight, should be offered counseling regarding contraception and appropriate contraceptive methods. However, obese youth who are sexually active may be less likely than their normal weight peers to use contraceptives correctly. Methods of contraception for obese adolescents are reviewed in this discussion. Combined oral contraceptives (COCs) and the contraceptive patch have higher failure rates in obese versus normal weight females, though failure rates are lower than noted with barrier contraceptives. The risk for venous thrombosis is higher in obese youth on COCs. Progestin-only pills and the levonorgestrel intrauterine system appear to be safe and effective methods in obese females. Depot-medroxyprogesterone acetate, intravaginal ring, and implants are also considered